1. Training in PMTCT: From the classroom to successful implementation
Theresa Ndoro(1), Zivanai Kapamurandu (1), Sophia Mkundu(2), Winnie Murigagumbo (2) Diana Patel (1), Barbara Engelsmann (1)
1 Organization for Public Health Interventions and Development Trust (OPHID), Harare, Zimbabwe 2 Ministry of Health and Child Welfare Zimbabwe
Zimbabwe National HIV&AIDS Conference, Harare, 5-8 Sept 2011

2. Background
Adequate and appropriately trained staff form a critical component for successful PMTCT programmes in Zimbabwe
Training an on-going process to:
- accommodate staff turnover
- introduce new policy changes

3. Issues Training diverts staff from routine duties
Increasing number of training workshops (PMTCT and others)
Ulterior motives of HCWs for attending workshops (“perdiemitis”)
Monitoring of quality of service delivery post-training
Lack of post-training follow up and support
Training generally expensive

4. Introduction
The Organisation for Public Health Interventions and Development (OPHID) as a partner in the FAI consortium, has been supporting MOHCW PMTCT programmes since 2001
OPHID supports the National PMTCT Programme mainly in the following areas:
- Financial and technical support during trainings for
health workers in key PMTCT courses
- Post-training follow up and constant support and
supervision to sites
- Community mobilisation
- Bi-annual PMTCT review and planning meetings
- Medical supplies support to sites
- Operational research

5. Approaches
In September 2010 OPHID supported training of 50 nurses from UMP and Mudzi districts (Mashonaland East Province)
Using standardised national training materials
In collaboration with MOHCW trainers
In EID/MER/M&E tools
In November/December 2010 systematic clinic based post-training follow up conducted by district co-ordinator together with MOHCW trainers
to assess implementation of the new regimen
to initiate corrective measures as and when
necessary

6. Outcomes Indicator UMP Mudzi Total number of health centres 19 21
Before September 2010
Number of sites implementing MER 1
In September 2010
Number of sites with HCWs trained in MER 18
Number of sites receiving MER starter packs after training 16 7
Number of sites implementing MER after training 6 4
December 2010
Sites supplied with starter packs during post training follow-up
Total Number of sites implementing MER after post-training follow-up 15 13

7. Observations
The most commonly reported reasons for failure to implement the new regimen at health centre level included:
- Lack of confidence in implementing the
new regimen, especially calculation of infant AZT regimens and DBS collection for EID
- Perceptions of additional workload
- Lack of will, “just another workshop”
- Lack of relevant logistics and supplies

8. Observations
Provision of and quality of service improved after post training follow-up in all sites
Increased confidence of HCWs to deliver services
Ability to deliver service improved e.g. calculate the dosage for the infant AZT regimens, even in bigger sites already implementing
Motivation improved
Appreciation of supplies delivered

9. Lessons Learnt For site level HCWs training alone is not enough
- need post-training follow-up
From Health workers’ perspective:
Presence of trainers at the sites reinforces the serious intent of the training and acknowledges the important role of HCWs at each site “Now that you have come I realise the importance of implementing the new regimen”

10. Lessons Learnt For site level HCWs training alone is not enough
- need post-training follow-up
From Trainers’ perspective:
Trainers better understand trainees working environment/local challenges and can identify gaps in individual knowledge and improve training approaches “Now you see where I am working”

11. Conclusions Systematic post training follow-up of trainees by trainers
reinforces changes of practice
optimises site performance
increases staff confidence and morale
guides modification of training approach and content

12. Recommendations
Ensure standardized regular, timely mentoring and supervision
of recently trained staff (particularly relevant in view of extensive IMAI/IMPAC training)
Need for development and dissemination of on the job aids e.g. calculations of infant ARV prophylaxis dosages
Ensure logistical availability of relevant resources soon after training
Review cost effectiveness of various training approaches

13. Acknowledgements Financial support (USAID, EGPAF)
Implementing partner (OPHID)
Provincial and district health executives
Nurses of health care institutions
Mothers

14. Thank you
HIV positive mother and her HIV negative son (Josphat) from a PMTCT program in Murewa, Zimbabwe 2009